Study: Hysterectomies are declining overall but alternatives to hysterectomy are still being underutilized.

ANN ARBOR, Mich. — A University of Michigan-led study of nearly 3,400 women in Michigan shows that one in five who underwent a hysterectomy for benign conditions may not have needed it.

The findings, which appear in the American Journal of Obstetrics and Gynecology, indicate that alternatives to hysterectomy are being underused and that treatment guidelines are often not followed.

An estimated one in three women in the U.S. will have had a hysterectomy by the age of 60. Researchers found that although the numbers of hysterectomies are decreasing, nearly 18 percent of hysterectomies that were done for benign indications were unnecessary, and a pathology analysis for nearly two in five (38 %) of women under 40 did not support undergoing a hysterectomy.

“Over the past decade, there has been a substantial decline in the number of hysterectomies performed annually in the United States,” says senior author Daniel M. Morgan, M.D., associate professor in the Department of Obstetrics and Gynecology at the U-M Medical School.

“An earlier study found a 36.4% decrease in number of hysterectomies performed in the U.S. in 2010 compared to 2002. However, despite the decrease in numbers of hysterectomies in the U.S., appropriateness of hysterectomy is still an area of concern and it continues to be a target for quality improvement.”

More than 400,000 hysterectomies are performed in the U.S. each year. About 68% of surgeries for benign conditions are done because of abnormal uterine bleeding, uterine leiomyomata (fibroids), and endometriosis. The American Congress of Obstetricians and Gynecologists recommends alternatives to hysterectomy, including hormonal management, a minimally invasive gynecological procedure called operative hysteroscopy, endometrial ablation (a procedure that destroys the uterine lining) and use of an intrauterine device as primary management of these conditions in many cases.

Researchers set out to assess how often alternatives to hysterectomy are being recommended to women with benign gynecologic disease before performing hysterectomy and how often the pathologic findings from the hysterectomy supported an indication for surgery. They examined the medical records of 3,397 women who underwent hysterectomies for benign conditions in Michigan. Data were collected over a ten-month period in 2013 from 51 hospitals participating in the Michigan Surgery Quality Collaborative (MSQC). Indications for surgery included uterine fibroids, abnormal uterine bleeding, endometriosis, or pelvic pain.

Nearly 40% of women did not have documentation of alternative treatment before their hysterectomy. Fewer than 30% received medical therapy, while 24% underwent other minor surgical procedures before the hysterectomy. Alternative treatment was more likely to be considered among women under 40 years old and among women with larger uteri. About 68% of women under 40 received alternative treatment compared with 62% of those aged 40-50 and 56% of those aged 50 or above.

Nearly two in five women under 40 (38%) had pathologic findings that did not support undergoing a hysterectomy versus those aged 40-50 (12%) and over 50 years (7.5%). The frequency of unsupportive pathology was highest among women with endometriosis or chronic pain.

LOS ANGELES (CBSLA.com) — For many women, mood swings and pain are a monthly ordeal, but in some cases, the cramping may be so severe women are taking drastic measures to find relief from the pain.
One such woman, who experienced cramps she described as mind-numbingly painful, was Leslie Valladares of Torrance, who searched to end years of suffering.

“I started having what I would assume were contractions,” Valladares recalls.

Valladares told CBS2’s Lisa Sigell she will be traveling 400 miles to Los Gatos to see the only doctor who’s been able to help her.

Valladares is a pediatric registered nurse but has been unable to find help closer to home.

For years, she says “Everybody’s basically telling me I’m not supposed to be in pain but I am.”

Valladares’ symptoms started at the age of 12. Every month, along with bleeding, she would experience excruciating pain.

Valladares says she saw one gynecologist after another about her painful periods and they would tell her, “Yes, mine is like that,” “Yup, it’s very painful,” or “We just have to all go through it.”

She says the message was clear: “Suck it up. Deal with it. We all do it. You can do it, too.”

“And I just thought something was wrong with me. Why can’t I handle this pain that everybody else seems to think is normal?” she asked.

It wasn’t normal and she wasn’t alone.

Valladares has endometriosis, or endo, a disease that affects one in eight women.

Andrew Cook, an endometriosis specialist in Los Gatos, is one of a handful of doctors nationwide who have devoted their careers to studying and treating the disease.

Endo, he says, “is tissue that’s similar to what we find inside the uterus. And it gets outside. It can grow through the bladder. It can grow in the liver. The diaphragm. And it can be horrendous.”

But it’s often hard to get help.

“Most physicians don’t get very much time in medical school being taught about it,” he explains.
Women can wind up stigmatized when they complain treatment doesn’t work.

Valladares had her first endo surgery in 2005 and three months later, the pain came back. When she told her previous doctor, she says: “He told me to look into fighting this pain medication addiction that he thought I had.” “It literally felt like he turned on me,” she said.

Cook explained: “Endometriosis tortures people. It doesn’t kill them, but there’s times you may wish it would kill you. It basically robs you from a normal life.”

Patients travel to Cook when all else fails.

“We deal with tough cases. On average, patients have been through three or four surgeries,” he explains.

His approach?

“I’m treating it with the same techniques as we would treat a cancer,” he said.

Surgeons typically burn away what they can see, and Cook says that isn’t always enough.

“You need to get around the lesion and cut it all out. If it’s not all removed, it’ll come back, just like if you don’t get all of the cancer out,” he said.

Cook’s meticulous surgical technique can take hours and isn’t cheap. Treatment can cost up to $10,000 out of pocket, but Valladares has no regrets.

“It almost feels like I woke up from this nightmare that I had for so long,” she said. “I feel like I’ve gotten this huge piece of my life back. I feel free.”

A telltale sign of endometriosis includes severe monthly cramping that gets worse as time progresses. Endometriosis can start in adolescence and can last beyond menopause. The condition is diagnosed via laparoscopic surgery. It is usually not detectible by ultrasound or other scans.

To learn more about endometriosis, click here. For information about Cook, click here or visit Amazon.com for more about a book he has written.
To find a list of endometriosis specialists, click here. To reach a support group via Facebook, click here.

This story was produced by CBS2 Medical Producer Gerri Shaftel Constant.

DOZENS of women suffering from endometriosis are having to undergo surgery twice because Basingstoke hospital does not have a specialist based there to treat the condition if it is severe.

It means that the majority of women who are diagnosed with the illness, which is incurable, and can cause chronic pain and fertility problems, face undergoing two lots of surgery – the first to diagnose the condition and the second to treat it.

Only those with mild endometriosis, which Basingstoke hospital has said is a minority, are given the option to have it treated during diagnosis.

The only way to properly diagnose endometriosis is via a laparoscopy, which is keyhole surgery to look inside the body.

The Endometriosis Institute, a not-for-profit organisation fostering research, education and clinical advances in endometriosis, states on its website: “An experienced laparoscopic surgeon should be able to resect or destroy endometriotic lesions with electrical current or laser at the time of diagnostic laparoscopy.”

Endometriosis UK, a charity supporting women with endometriosis, in offering information to those waiting for a laparoscopy, adds: “A laparoscopy is carried out under general anaesthetic. At the same time, various procedures can be performed in order to destroy or remove the endometriosis, endometriotic cysts and release scar tissue.”

Basingstoke hospital said that 131 women had endometriosis diagnosed via a laparoscopy between July 2013 and July 2014, of which only a “minority” were able to receive treatment during this surgery.

The hospital, in Aldermaston Road, said following diagnosis, a treatment plan is formulated and patients may be referred to the Royal Hampshire County Hospital, in Winchester, where the specialist endometriosis centre is based.

Basingstoke hospital has not been able to provide figures to show how many women are referred for further surgery following diagnosis.

Some may choose to receive hormonal treatment to control the endometriosis instead, although this does not get rid of it.

Claire Iffland, clinical director of obstetrics and gynaecology at Basing-stoke hospital, said that Hampshire Hospitals Foundation Trust has several endometriosis experts, but added: “They are unable to undertake all the diagnostic laparoscopies, the majority of which will not result in a diagnosis of endo-metriosis.”

She added: “It is not possible to know in advance which women have endometriosis, or for those who do have it to know in advance how extensive the disease is.

“One of the difficulties with endometriosis is that there is little correlation between the symptoms a women experiences and the extent of any endometriosis.

“Operating lists have to be planned to take into account the likely length of time of a procedure and the skills and training of the surgeon performing the investigation.

“Endometriosis surgery can take the form of a few minutes of simply diathermy which can be undertaken by the majority (but not all) doctors who do diagnostic laparoscopies.

“Equally the surgery required may be extensive and require time and significant expertise to achieve.

“At Basingstoke, we usually offer diagnostic laparoscopy first, followed by a discussion with the patient and a planned procedure which takes into account the likely length of time of the procedure for that particular individual and whether or not she needs complex treatment by an endometriosis expert.”

Canadian endo sister forced to wait for laparoscopy – told she will “not suffer death or irreversible tissue damage”, so she should stop “doctor shopping, since this was a waste of both health-care resources and her time.” She was of course in agonising pain. Turns out once she came to the States to get surgery at Northside Hospital Cancer Institute, the surgeon had to remove her uterus, fallopian tubes, ovaries and nearly 8 inches of her bowel because of extensive endometriosis damage.

OHIP turns blind eye to suffering
COVERAGE: Area woman was chastised for seeking faster care before agency threw up roadblocks to paying for her care
By JONATHAN SHER, THE LONDON FREE PRESS
Last Updated: January 20, 2012 9:55pm

Chastened by doctors for seeking speedier treatment for a painful disease threatening to rob her of fertility, Allison Jones writhed with pain so severe it was like a man continually passing large kidney stones.

Jones needed to see one of a handful of gynecological specialists who could remove the lining of a uterus where it grows outside that organ, a painful condition called endometriosis.

But after waiting seven months to see a specialist Jones, a resident of Southwestern Ontario, was told she’d have to wait at least seven more for surgery that might make her pain-free for the first time in years.

Only one specialist held an open door to her care, a Canadian schooled almost entirely in Ontario. But Dr. Ken Sinervo had committed a Cardinal sin as far as OHIP was concerned — he offered life-changing surgery outside the country in Atlanta, Georgia.

Twice, Jones’ family doctor wrote to OHIP, asking the agency to pay for Siverno’s surgery, but each request was met by quick refusals and a suggestion she check a list of specialists, none of whom had time to see her any quicker.

One specialist, Dr. Sabrina Lee, chastised Jones for seeking faster access, writing in a letter she should stop “doctor shopping, since this was a waste of both health-care resources and her time.”

Jones sought emergency care repeatedly, but the heavy-duty drugs prescribed did little to curb her pain.

So in April of 2010, she decided to go to Atlanta.

Three days later, she was on an operating table at the Northside Hospital Cancer Institute.

“That’s one of the big differences between the health-care system in Canada and the system here,” Sinervo told The Free Press this week from Atlanta.

The disease had progressed so quickly, Sinervo had to remove her uterus, fallopian tubes, ovaries and nearly 8 inches of her bowel.

The ordeal was traumatizing. Jones — not her real name — asked The Free Press last week to keep her identity secret.

But those who helped her spoke out.

It isn’t just the speed of access that’s different, Sinervo says. The surgeries he performs in Atlanta are more advanced than what’s available in Ontario, in part because he performs surgery four or five days a week — while Ontario docs might get a day and a half because of the rationing of operating-room time.

“That’s one of the reasons I didn’t go back to Canada after my fellowship in Atlanta,” he said.

Sinervo uses a carbon-dioxide laser to remove all of the abnormal tissue to lessen the chance of complication and reoccurrences, something he says most specialists do not do.

The surgery was done, but the struggle for Jones had just begun: She faced a $70,000 medical bill including close to a week in hospital.

The Atlanta hospital, Northside Hospital Cancer Institute, later forgave most of the bill, wiping $57,000 off the books as it sometimes does for patients who just can’t afford to pay.

But OHIP fought against covering the remaining $13,000, even though that amount is almost certainly no more than what Jones’ treatment would have cost in Ontario, Sinervo said.

That hard-nosed approach is nothing new for OHIP, says the lawyer who represented Jones. For 20 years, the agency has acted strictly like a private insurance company, going to great lengths to avoid having to pay for any out-of-country care.

“There’s no compassion at all,” said Perry Brodkin, who was the agency’s in-house counsel years ago, before regulatory change changed it from an agency that tries to help to one seeking any reason to reject coverage.

Most patients lose appeals to OHIP rejections because they can’t afford to hire a lawyer, as legal costs typically range between $5,000 and $20,000.

Patients argue on compassionate grounds not to be found in a law that restricts out-of-country coverage to necessary care that’s unavailable here or so delayed a wait would probably result in death or medically significant and irreversible tissue damage.

Pain alone isn’t enough to get OHIP funding, no matter how excruciating or debilitating, Brodkin said.

But this time the bad guys lost, Brodkin said.

Jones won her appeal this month before Ontario’s Health Services Appeal and Review Board.

Board members took issue not just with the stance of OHIP, but also with the Ontario specialists who had essentially told Jones to wait her turn.

The specialist she was to have waited for was Dr. Nicholas Leyland, top dog at Health Sciences Centre at Hamilton’s McMaster University.

But when Jones went to Sinervo, Leyland wrote to support OHIP’s denial of coverage.

“We could have carried out the same kind of care that was provided by Dr. Sinervo, who was a trainee of ours a few years ago. This patient would not have suffered death or irreversible tissue damage in waiting for this surgery. Many patients are waiting for this procedure much longer,” Leyland wrote.

The board rejected Leyland’s claim, noting in his letter, he didn’t mention Jones’ specific condition or if delay would cause irreversible tissue damage, dismissing her claim because some other women with the same general condition had to wait longer.

“It is unfortunate that Dr. Leyland did not testify at the hearing,” the board wrote.

The board also took aim at OHIP: “The Appeal Board is troubled by (OHIP’s) assertion that since endometriosis is by definition a progressive disease, any further progression in the form of tissue damage is expected and is not medically significant.”

The decision is timely, Brodkin said, as waits for surgery by Leyland have grown to nine months, with about 60 women affected.

“Most wait and suffer damage,” he said. “(This case) may open the doors (for care in Atlanta),” Brodkin said.

The Toronto lawyer challenged Ontario Health Minister Deb Matthews to change the rules and process to give patients a fighting chance, even if it’s to arrange for an advocate or ombudsperson for those who can’t afford a lawyer.

As for Sinervo, he’d like to negotiate a reduced rate with the health ministry for Ontario women going to Atlanta’s Center for Endometriosis Care, something close to half of the regular charges.

The Free Press requested interviews three days this week with Matthews, a London MPP, but she didn’t make herself available.

While reading this article, put it in the context of managing endometriosis. Many of us have had repeat surgeries, only to still be in debilitating pain.

Our illness is likened to cancer, except that it doesn’t (usually) kill us. The very fact that our illness is compared to and staged like cancer is enough for one to read the article below and nod knowingly; we do not want to continue to be lab rats.

We only want to be made as comfortable as possible while dealing with the unbearable pain. We only want to live as full and joyful a life as possible in spite of the pain. Every moment the pain level takes a dip, we want to use that moment to its fullest. This is not so different than a terminal patient, in my opinion.

How Doctors DieIt’s Not Like the Rest of Us, But It Should Be
by Ken Murray

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

I had the chance to educate a doctor for Endometriosis Awareness Month.

On February 28th I came down with the flu. I went to the doctor, who asked if I’d had my flu shot. I said no, because I’m allergic to eggs (flu shots are created using chicken eggs, did you know?). He then suggested I try Tamiflu. I told him I have previously examined the drug and its side-effects, and decided that my sensitivity to meds, coupled with dealing with autoimmune disease, did not make it appealing to chance multiple side effects on the off chance that the flu might be lessened by one or two days.

The doctor asked what autoimmune disease I have, so I told him I have endometriosis. He looked annoyed, put down his pen, looked at me and said, “Endometriosis is not an autoimmune disease.”

My jaw dropped. I politely told him that the confirmation on this is fairly recent, so yeah, it’s actually an autoimmune disease. Meanwhile, his intern student doctor, standing to my left, murmured under his breath, “yes, it is an autoimmune disease.”

The doctor retorted angrily at me, “It is NOT an autoimmune disease!”

I thought for sure his next comments would be something about endometriosis MERELY being painful period, and why don’t I try some Midol to ease the cramps…he was at that level of condescension.

I told him “First of all, I’m the one with the disease, so I’ve done my homework, so yes, it IS an autoimmune disease, and secondly, there has been proven anomaly on chromosomes 1 & 7, WOULD YOU LIKE COPIES OF THE STUDIES, since I am subscribed to medical journals?”

The intern again quietly agreed, “it is an autoimmune disease.”

The head doctor wanted to hear none of it. Red-faced with rage, I informed him that I’d be inserting the studies into my medical file for his education.

THIS IS THE TWENTY-FIRST CENTURY, AND YOU ARE IN A SUPPOSEDLY DEVELOPED NATION, IN A SUPPOSEDLY HIGH-TECH DOCTOR’S OFFICE, TELLING ME WITH YOUR IGNORANCE THAT YOU ARE NOT UP ON THE LATEST MEDICAL RESEARCH?!?!?!?!

This is the second doctor’s office I have chosen in this city. I see I may have to fire this office, too. Sadly, I’m certain that all local doctor’s offices are this stupid. When I was leaving the exam room, the intern held the door for me. I smiled and quietly thanked him for backing me up. He grinned and replied that he was looking forward to the heated debate on the topic. It seemed like he was trying to tell me that he’d be in trouble for agreeing with the patient, and that it wasn’t his first run-in with the doctor. Ugh, poor intern. I sincerely hope he makes it out of med school in one piece.

When I got home from the doctor’s appointment, I called the office and told them to put it in my file that I will never see Dr. James E. Eichel again. As a matter of fact, my husband reminded me that the reason he left that doctor’s office the first time around in search of another family practice was because of Dr. Eichel’s condescending attitude.
I did a background check on him, nothing comes up. But take it from me and my husband, the guy is not worth your energy. Also, check out doctor reviews on the web – numerous people have found him to be condescending and rude.

I was so angered by this doctor telling me that my debilitating chronic illness is not in as valid a category as he feels it should be, that it has taken me 24 DAYS to write about it, and even now, this is the best verbiage I can find without using a string of expletives and then throwing something across the room.

BEND, Ore. — A Bend gynecologist facing state Medical Baord disciplinary action over involvement with now-indicted real estate broker (and former patient) Tami Sawyer said Saturday his license is still valid and he’ll be back to work Monday.

Dr. David Redwine, who won a still-unpaid, hefty judgment against a company run by Tami and Kevin Sawyer, faces possible suspension or revocation of his medical license over state findings of “unprofessional or dishonorable conduct” and “gross or repeated acts of negligence” involving Tami Sawyer.

“The board has not diminished my license at all. I’ll be seeing patients Monday and I’m scheduled to operate Tuesday,” said Redwine, who has less than two weeks to seek an appeal hearing or face as-yet undetermined consequences that could range from revocation or suspension of his license to practice medicine, to a fine or reprimand.

Redwine told KTVZ.COM he is out of town visiting family and “will be talking with my attorney about filing an appeal hearing.”

The physician said he could not speak to the issues until he discusses matters further with his attorney, but added, “We need to let the process take its course.”

The Oregon Medical Board issued a complaint and notice of proposed disciplinary action Oct. 21 against Redwine, a physician and surgeon specializing in endometriosis and gynecology.

The state’s findings come nearly a year after Tami Sawyer filed a malpractice lawsuit against him, accusing him of a consensual sexual relationship with her when she was a patient and improperly prescribing medicines to her and her family members.

The state findings detail much of the same claims, showing that Redwine disputes Sawyer’s claim of how long the relationship lasted.

Sawyer claimed this week that no judge in the area would hear the malpractice case and had recused themselves.

Last week, Tami and Kevin Sawyer were indicted on 21 federal charges of fraud, conspiracy and money-laundering charges. They are due for arraignment in Eugene Nov. 8.

Tami Sawyer agreed in March 2009 to a judgment on behalf of their company, Starboard LLC, in a lawsuit filed by Redwine and wife Laurie against the Sawyers’ company, Starboard LLC, for more than $800,000 invested in the company that they never got back.

Sawyer almost went to jail on contempt of court charges a year ago, for refusing to divulge details of the company’s finances, but the Oregon Court of Appeals stayed that order, saying she was likely to prevail on appeal. The judgment has not been paid.

The state Medical Board complaint says Redwine first provided obstetric and gynecological care for Sawyer, identified as “Patient A,” in the late 1980s and they also began business transactions in the late ‘90s, including Redwine making loans to Sawyer for real estate investments.

According to Sawyer, the two “entered into a sexual relationship beginning in 1999 and culminating in the fall of 2007,” the complaint said, while Redwine recalled “a shorter time span” of “a sporadic sexual relationship beginning in late 2004 and extended into 2005.”

The state complaint says Redwine “wrote various prescriptions” for the patient between 2004 and 2007, and also “wrote occasional prescriptions for (Sawyer’s) family members at her request, without the benefit of conducting an examination or maintaining a chart.”

In 2005, the complaint says Redwine “performed a breast examination on (Sawyer) in a social setting that was witnessed by a family member and friend.” It says Redwine terminated their doctor-patient relationship in an April 2008 letter.

Greta Matus, an investigator with the Oregon Medical Board, said Friday the nature of the disciplinary action against Redwine has not been decided. If Redwine does not seek a contested case hearing, the complaint said that will result in a dfault order by the board as it “deems appropriate.”

Sawyer told KTVZ.COM on Friday, “It’s very sad it’s come to this.”

“Why David’s attorney … deposed me about David and (my) past relationship is still a mystery to me,” she wrote.

“He had to know that when all of my attorneys read it, there would be further investigation surrounding that fact,” Sawyer said.

“Lives and careers have been ruined,” she added. “It’s just incredibly sad to me.”

I just want to scream, “How dare you be rotten like so many others out there! You were supposed to be one of the good ones!”

There just aren’t enough good endometriosis surgeons out there as it is, and he is ranked as one of the rock stars out there. I have recommended him for years. To fall from grace like that – who loses? The patients lose.

No one has (yet) accused him of butchery like some of the other former rock star surgeons out there have been accused, but his disciplinary action is still a tragedy because he used very poor judgement while emotionally and sexually involved with a patient, and emotionally involved with her family.

Even if his medical license does not get revoked, I will never see him now, and I will not recommend him.